Recurrent Vaginal Candidiasis Treatment Guidelines

Diagnosis and Initial Treatment

The Infectious Diseases Society of America recommends that recurrent vulvovaginal candidiasis (RVVC) be defined as ≥4 episodes of symptomatic infection within one year 2
Before starting treatment, diagnosis should be confirmed with wet-mount preparation using saline and 10% potassium hydroxide to demonstrate yeast or hyphae, and verify normal vaginal pH (4.0-4.5) 1
For patients with negative wet mount findings, vaginal cultures for Candida should be obtained 2
Initial control of the recurrent episode requires induction therapy with either topical antifungal agent for 10-14 days or oral fluconazole 150 mg every 72 hours for a total of 2-3 doses 1, 2

The Infectious Diseases Society of America strongly recommends maintenance therapy with fluconazole 150 mg weekly for 6 months after initial control of the recurrent episode 1, 2
This regimen achieves control of symptoms in >90% of patients 2
After cessation of the 6-month maintenance therapy, a 40-50% recurrence rate can be anticipated 2

Most recurrent infections are caused by C. albicans, which responds well to fluconazole 2
For C. glabrata infections, topical intravaginal boric acid (600 mg daily for 14 days) is recommended 1, 3
Alternative options for C. glabrata infections include nystatin intravaginal suppositories (100,000 units daily for 14 days) 1

Patients should be monitored for symptom recurrence after completion of maintenance therapy 2
If symptoms recur after completing the 6-month regimen, consider restarting the maintenance regimen 1, 2